WAYNE ANTENEN Pharmacist License verification

Business Entity

CANCELLED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049057312

License Status

CANCELLED

Business

First Name

WAYNE

Last Name

ANTENEN

Business Name

WAYNE ANTENEN

Original Issue Date

02/02/1972

Effective Date

02/02/1972

Expiration Date

01/01/1997

City

ST. JACOB

State

Zip

62281

County

MADISON

Ever Disciplined

LastModifiedDate

10/17/2005